| Theme | Autoimmune Pancreatitis | |
|---|---|---|
| Title | Clinical Diagnostic Criteria for Autoimmune Pancreatitis | |
| Publish Date | 2010/08 | |
| Author | Kazuichi Okazaki | Department of Gastroenterology and Hepatology, Kansai Medical University |
| Author | Takeo Kusuda | Department of Gastroenterology and Hepatology, Kansai Medical University |
| Author | Takashi Tomiyama | Department of Gastroenterology and Hepatology, Kansai Medical University |
| Author | Kazushige Uchida | Department of Gastroenterology and Hepatology, Kansai Medical University |
| [ Summary ] | We compare the Japanese clinical diagnostic criteria used in 2006 with those in Korea and the United States and discuss current and possible future issues related to diagnosis of AIP. The basis of the Japanese criteria is practical usage to differentiate AIP from pancreatic or biliary malignancy, but not to differentiate it from systemic disorders. Therefore, that is the primary use for standard AIP but not for screening AIP. For pancreatic imaging, typical pancreatograms with CTs or MRIs are required according to the Japanese and Korean criteria, but not according to the Mayo criteria. ERCP is mandatory in the Japanese criteria, but MRCP is also available in the Korean and Mayo criteria. The presence of autoantibodies in addition to high serum IgG4 levels in blood tests are components of the criteria in Korea and Japan, but not the Mayo criteria. Irrespective of laboratory or radiological data, only LPSP is definitive for diagnosis of AIP according to the Mayo criteria, but not according to the Japanese or Korean criteria. The Mayo and Korean criteria define dense infiltration of IgG4 positive plasma cells observed in the pancreatic specimens as being useful for diagnosis when LPSP is not confirmed. Extra-pancreatic lesions are included in the Korean and Mayo criteria but not in the Japanese. Trials of steroidal treatment for the pancreas and/or extra-pancreatic lesions are a component of the Korean and Mayo criteria, but not the Japanese. However, pancreatic malignancy may accompany AIP. Although steroid trials may indicate increased diagnostic sensitivity for AIP, the efficacy of steroids should be carefully evaluated. Overly simple therapeutic diagnoses are not recommended in Japan at this time. | |